利妥昔单抗联合化疗方案治疗原发性中枢神经系统淋巴瘤的疗效  

Efficacy of rituximab combined with chemotherapy regimen for the treatment of primary central nervous system lymphomas

作　　者：孙雪飞[1] 刘静[1] 孙胜军 王亚明[4] 陈悦丹 邢瑞娴 白雪燕[1] 钱筠[1] 朱红[1] 季楠 刘元波[1] 

机构地区：[1]首都医科大学附属北京天坛医院血液科,100050 [2]神经影像中心 [3]神经外科 [4]海军总医院神经外科

出　　处：《中华神经外科杂志》2016年第4期388-392,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81272842）

摘　　要：目的评估利妥昔单抗联合大剂量甲氨蝶呤、阿糖胞苷及地塞米松（R—MAD方案）治疗原发性中枢神经系统淋巴瘤（PCNSL）患者的有效性及安全性。方法回顾性分析2010年1月至2015年6月首都医科大学附属北京天坛医院血液科治疗的35例PCNSL患者的临床资料。所有患者均给予利妥昔单抗（d0：375mg／m2）、大剂量甲氨蝶呤（d1：3．5g／m2）、阿糖胞苷（d2：0．5～1g／m2）及地塞米松（d3：10mg／d）治疗，每21天为1个疗程，治疗4～6个疗程。结果35例患者的中位随访时间为36（6—66）个月，其中20例（57．1％）达到完全缓解，13例（37．1％）达到部分缓解，2例（5．7％）疾病进展，总有效率为94．2％（33／35）。中位生存期为38．3个月（95％CI：19．5～7．2），中位无进展生存期为30．0个月（95％CI：9．4—50．6）。不良反应以骨髓抑制为主，24例（68．6％）患者病程中出现了1～3级白细胞减少及血小板减少，无4级及以上不良反应。结论利妥昔单抗联合大剂量甲氨蝶呤、阿糖胞苷及地塞米松方案治疗原发性中枢神经系统淋巴瘤安全、有效。Objective To evaluate the effectiveness and safety of rituximab combined with high- dose methotrexate, dexamethasone and dexamethasone （R-MAD regimen） for the treatment of patients with primary central nervous system lymphoma （PCNSL）. Methods The clinical data of 35 patients with PCNSL treated at the Department of Hematology, Belling Tiantan Hospital from January 2010 to June 2015 were analyzed retrospectively. All patients received rituximab （ do ： 375 mg/m2 ） , high-dose methotrexate （ dI ： 3.5g/m2 ）, eytarabine （ d2 ： 0.5 - 1 g,/m2 ）, and dexamethasone （ d1-3 ： 10 mg/d） for chemotherapy. Every 21 days were as a course of treatment, and they were treated for 4 - 6 courses. Results The median follow-up time of 35 patients was 36 （ 6 - 66 ） months, 20 （57. 1% ） of them achieved complete remission, 13 （37.1%） achieved partial remission, and 2 （5.7%） had progression of disease. The total effective rate was 94.2% （33/35）. The median survival time was 38.3 months （95% confidence interval [ CI] 19.4-57.2）, and the median progression-free survival was 30.0 months （95% CI 9.4 -50.6）. The adverse reaction of chemotherapy was mainly bone marrow suppression. Twenty-four patients experienced grade 1 to 3 neutropenia and thrombocytopenia in the course of the disease. No grade 4 and above adverse reactions were observed. Conclusion R-MAD regimen is both safe and effective in the treatment of primary central nervous system neoplasms.

关 键 词：中枢神经系统肿瘤 淋巴瘤 免疫疗法 药物疗法 甲氨蝶呤 阿糖胞苷 原发性 利妥昔单抗 

分 类 号：R739.41[医药卫生—肿瘤]